WHO CleanHandsNet
Call for Action
PROFESSOR DIDIER PITTET
On 5 May 2010,
witnessed an unprecedented
global commitment
improving hand hygiene in
health care
demonstrates the
that
considerable increase in awareness and activities in
most parts of the world. But our goal of sustained
hand hygiene improvement at every point of patient
care is still far from reached.
Many different interventions are required to prevent
and control health care-associated infections (HAI).
While HAI surveillance systems exist in many
developed countries, only about 16% of developing
countries report a functioning national surveillance
system. Yet HAI rates, when known, are markedly
higher in developing countries, with up to 19% of
patients estimated to acquire HAI hospital-wide.
Surgical site infections are the most frequent type of
infection and can occur at rates of up to 25% of all
surgical procedures. Ventilator-associated
pneumonia occurs up to 17 times more frequently
than in developed countries with an excess mortality
rate as high as 27%. Neonatal infections are three to
20 times higher in developing countries than in
industrialized countries and are responsible for 4% to
56% of all causes of death in the neonatal period.
If hand hygiene is a basic factor for reducing HAI,
why do most studies show that compliance continues
to be far less than optimal? There are many reasons.
To help identify the barriers in the health-care
facilities in your area, I invite you to use the newly
issued WHO Hand Hygiene Self-Assessment
Framework. Although designed as a hand hygiene
tool, it can also help to identify other systemic issues
requiring action and can be used at regular intervals
to map progress:
http://www.who.int/gpsc/country_work/hhsa_framewo
rk/en/index.html.
We also ask that you continue to encourage other
countries and states in your region who may not have
centrally coordinated activities, to initiate such
actions. For centrally coordinated programmes, we
now provide additional tips on campaigning as well
as summarised guidance on using our tools at the
following link:
http://www.who.int/gpsc/national_campaigns/PS_han
d_hygiene_tools_2010_6_en.pdf.
© WHO, 2010
we
to
well
January - June 2010:
A Summary update
from Clean Care is
Safer Care
Secretariat
From January to May 2010, the team
focused on achieving their goals for the
5 May 2010 annual global campaign.
New information now posted on the
SAVE LIVES: Clean Your Hands web
pages
(http://www.who.int/gpsc/5may/en/)
Includes the Hand Hygiene Moment 1
Observation Tool and global survey,
the Hand Hygiene Self-Assessment
Framework, and the 'evidence for hand
hygiene' pages.
Over the past months, we have also
been discussing how best to establish
priority areas of work and clear work
plans for moving forward in the current
WHO biennium (2010-2011), as well as
a plan for programme evaluation;
engaging with the CleanHandsNet
participants has been identified as one
of our priorities. Translations of WHO
hand hygiene tools into other official
WHO languages is also progressing
well, with many French translated tools
already on the web. The "5 Moments"
training film is being updated and when
ready, we will post more information on
our website. The Team is interested in
the progress on hand hygiene
promotion and HAI prevention activities
in different parts of the world and have
been gathering information from all
NO 2, JUNE 2010
countries that have signed commitment
to reduce HAI. If you have received a
request from us on the topic of your
country's pledge to reducing HAI,
please complete the survey and
provide us with this valuable
information.
Finally, thank you all very much for
your efforts in meeting the objectives of
the SAVE LIVES: Clean Your Hands
initiative on 5 May 2010. A report of our
activities and lessons learnt will soon
be finalised and a forward strategy for
coming years developed. Comments
from you on WHO's coordination of
SAVE LIVES: Clean Your Hands and
from your country/local efforts are
welcome (email: savelives@who.int).
More information on next year's call for
action on May 5 will be communicated
to you as it becomes available.
Remember that the monthly Save
Lives newsletter provides you with
regular updates of many activities and
we appreciate your wide dissemination
of this.
As you are aware, the meeting of the
Network this year will not go ahead as
planned. We are making every effort to
reschedule this meeting fairly soon. In
the meantime, let us continue to progress
our agenda of improving compliance with
hand hygiene recommendations at the
point of care everywhere. We are also
planning some activities where all
participants can get involved actively and
can be coordinated through electronic
means of communication. We will contact
you as soon as plans are clearer and we
look forward to your continued support.
Lessons learned four
four years on
on: the case of • Have a clear way to evaluate the impact of the different pieces of
England and Wales hand hygiene improvement work you engage in, as this will tell
J.P. Nolan you what to keep and what to change;
The multi-award winning cleanyourhands campaign • Many people are trying to get the attention of your audience:
(handhygiene@npsa.nhs.uk), the national hand hygiene campaign of design your messages and creative tools to have a competitive
England and Wales, is now in its fourth year with 100% of hospitals advantage and link them to what motivates the people you are
and 97% of other health-care organizations in the area registered. To trying to influence;
mark the start of the New Year in hand hygiene, we have produced a • Ensure that your work promotes local ownership. This will
review “Stopping infection in its tracks” which chronicles four years of future-proof improvements;
cleanyourhands. This document was circulated to every health-care • Persevere. Changing behaviour takes time, this is to be
facility in England and Wales to encourage reflection on expected. Reward small improvements, this will lead to more
achievements to date and work ahead. We invite you to read this small improvements and eventually you will reach your goal.
publication on our website at
http://www.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=735
13&type=full&servicetype=Attachment

As we move into a new campaign year and look towards the future,
some important questions must be asked. Are we still needed and
can we still add value to patient safety? The answer from our
members is yes. Even after four years, 87% of cleanyourhands
members rate our multimodal materials as “essential” or “very useful”.
In addition to our users' views, evidence of our success also comes
from an independent evaluation of the campaign which demonstrated
an increasing level of hand hygiene consumable procurement
throughout the campaign's lifespan. On 5 May, the campaign team,
along with key stakeholders from partner organizations, met in
London to ask “what next?” The National Patient Safety, Royal
College of Nursing, Infection Prevention Society and a number of
News from the Network on activities
health-care organizations (including the original cleanyourhands pilot
sites) were represented at this meeting. related to 5 May 2010
Thank you for submitting your feedback and activities to us. Many
High on our agenda was the need to avoid campaign fatigue and to activities were also shared in the lead-up to 5 May 2010.
ensure sustainability. Cleanyourhands will now undertake a strategic (http://www.who.int/gpsc/5may/country_events/en/index.html). Please
review and update our objectives to ensure that it is still perceived as note that due to the overwhelming response regarding local activities
relevant for today. Our initial objectives were set four years ago. As in and limited space in this newsletter, we had to edit some of the
every nation, a health service undergoes many changes in four pieces to accommodate all submissions.
years.
Bangladesh
Debasish Dutta
After a number of years of campaigning, it may be necessary to
change or expand our audience. In doing so, the reality of being able On 5 May 2010, the day was highlighted with a rally, discussion

to engage and motivate must be considered. Our experience is that meeting and dissemination workshop with pilot performance indicator

different target audiences are motivated by different messages. For and scale-up strategy. High ranking officials from the hospital,

this reason, it is essential to be clear that the messages delivered are Medical College, Government, WHO officials, as well as all the

linked to the motivations of the audience. professors, doctors, nurses and other supporting staff of Chittagong

In summary, the following themes emerged from our experiences: Medical College Hospital participated. Promotional items were

• Ensure your hand hygiene messages are reaching the correct distributed during the rally: t-shirts and caps with the slogan "Save

audience to impact patient safety; Lives: Clean Your Hands" to create awareness among health-care
workers.
 to leaders and health-care workers. In the Albert Einstein
Hospital (Sao Paulo-SP), the central theme of the campaign was
"Perform Hand Hygiene - Make this commitment". Health-care
professionals signed a commitment to perform hand hygiene
correctly and received a bottle of alcohol gel and a card with "My 5
Moments for Hand Hygiene" to be placed on the badge. Characters
impersonating Florence Nightingale and Ignaz Philipp Semmelweis
also participated in the activities!

Croatia
Zrinka Bošnjak
For the 5 May 2010 campaign, a two-day meeting and workshop

Brazil entitled 'An Audit to control Health Care-Associated Infections' was

Heiko Santana and Fabiana Sousa organized by the University Hospital Centre in Zagreb.
The National Health Surveillance Agency (Anvisa), the Brazilian
Ministry of Health and the Pan-American Organization in Brazil
(PAHO/WHO), disseminated information on 5 May to all municipal
and state health coordination, municipal and state health
surveillance, state infection control coordination, professional
associations on infection prevention and control and Brazilian
hospitals. A website was created to disseminate information
http://www.anvisa.gov.br/hotsite/higienizesuasmaos/index.htm

Iceland
Ása Atladóttir
To highlight 5 May, the campaign lead in Iceland submitted articles to
the popular media. This article was also published online

Brazilian hospitals were encouraged to register on the WHO website (http://www.landlaeknir.is/Pages/1055?NewsID=2140)

to assist WHO in the 2010 target and Prof Pittet's webinar, Improving
hand hygiene worldwide, was posted on the Anvisa website. On the
evening of 5 May, a web-chat was coordinated by Dr Antonio Tadeu
Fernandes, a professor and well-known infectious diseases specialist
in Brazil, to discuss this global day with health-care professionals.
Other local activities included lectures and guidance on hand hygiene
for health-care workers, training on alcohol handrubbing technique,
continuous screening throughout the day of a film on hand hygiene
and informing employees of the institution about the importance of
the work being done by its Infection Control Committee. WHO
Jordan
posters on 'My 5 moments for hand hygiene' and a banner on the Rajaa Khater
theme were exhibited. Also, bottles of alcohol-based handrub, To celebrate 5 May, several activities were conducted in Prince
brochures and buttons were distributed to the health-care Hamzah Hospital, Jordan. In collaboration with the National Advisory
professionals. An institution currently implementing hand hygiene Committee, a hand hygiene awareness campaign was launched. In
promotion has adopted a zero-tolerance to the lack of hand hygiene. addition, a conference for staff and students, quiz and training by
infection control nurses for staff were organized. Posters depicting
Observation of compliance with "Moment 1" was performed in several
units of the Albert Sabin Hospital (Fortaleza-CE) and data presented
the "5 Moments for hand hygiene" and hand hygiene technique were
placed in all departments.
Mongolia
Ganchimeg Gombosuren
The Mongolian Quality Managers' Association has been successful in
naming 5 May as “Clean Hands Day”. Forty-five health organizations
conducted a joint meeting and workshop for health workers and the
general public and distributed 5200 posters and over 7000 guidelines
on hand hygiene. In addition, the Ministry of Health and
Epidemiologists Association together organized a ”Clean care is safer
care” workshop. Representatives included from the Ministry of Health
and Department of Health officials, heads of health organizations,
epidemiologists and health workers. In total approximately 70
participated.

There is now a plan to monitor adherence to proper hand hygiene

using WHO tools and to repeat educational activities every month. In
collaboration with JNMC (Jordan Nurses & Midwives Council), the
message “Save Lives: Clean Your Hands" was texted to 5000
nurses' mobile phones.

Luxembourg
Elisabeth Heisbourg Philippines
Philippines
Armando C. Crisostomo
In November 2009, the Luxembourg Ministry of Health launched the
The Philippines Alliance for Patient Safety (PAPS) contributed to the
first national hand hygiene campaign with the participation of all
global call made by the WHO Saves Lives: Clean Your Hands
hospitals and with commitment of several partners in this sector (the
initiative by establishing a mobile phone text "brigade" to alert all its
National Association of Physicians and Dentists, Association of
member organizations and affiliated health-care facilities. PAPS used
Hospitals, National Association of Nurses, etc). This campaign was
this speedy yet efficient medium of texting to encourage all health
developed in collaboration with the Luxembourg infection control
professionals to perform hand hygiene. The text message read: 'This
practitioners and the support of the promoters of the Belgian hand
May 5, we join WHO in renewing our commitment to CLEAN HANDS,
hygiene campaign. The campaign fully adopted the WHO Hand
SAVES LIVES. At 10 AM on May 5, let's drop what we are doing and
Hygiene Guidelines and the multimodal strategy. Alcohol handrub
wash our hands for 10 seconds to show our support - KALINISAN
consumption was monitored and pre- and post campaign measures
NG KAMAY, KALIGTASAN NG BUHAY! Please Pass!'
of hand hygiene compliance were conducted in each hospital. The
plan is now to extend the campaign to the nursing home and home
care sectors.

The text message was sent through various professional

organizations such as the Philippine Medical Association, the
Philippine College of Surgeons, the Philippine Society of
Spain
María del Mar Fernández Maíllo
Anaesthesiologists and Nurses Association, as well as to major
For 5 May 2010, 58% more facilities registered their commitment and
hospitals in the Metro Manila area including the Philippine General
more Health Region authorities joined the effort to spread the 'Save
Hospital, Manila Doctors Hospital, UST Hospital, St. Luke’s Medical
Lives' message. Messages were delivered to health-care
Center and the Asian Hospital and Medical Center.
professionals, scientific societies and associations of patients and
citizens involved in the national net of patient safety educators.
At the Asian Hospital and Medical Center, a two-day programme was
held on May 5-6 to celebrate the first anniversary of their clean hands
National and particularly local media disseminated hand hygiene
campaign. The activities included not only lectures from infectious
information through conventional and electronic press, as well as TV
disease specialists, audio-visual presentations and demonstrations,
broadcasts.
but also story-telling and hand-painting sessions for children. The
hospital also launched their Statement Shirt and Hand washing
Workshops and information sessions were organized and
Activity Book for children. This institution lived up to their
supplemented with promotional materials such as posters, leaflets,
commendation from WHO for their innovative programmes.
brochures and other items. Institutional websites replaced their

Scotland mailing logos with clean hands and launched campaign

screensavers. Hospital and ambulatory centres broadcast informative
In 2005, the Scottish Minister for Health and Community Care
videos through their TV channels and some conducted surveys on
pledged to develop and fund a national hand hygiene campaign in
knowledge and attitude related to hand hygiene.
Scotland. Consequently, in January 2007, Scotland’s Hand Hygiene
Campaign, ‘Germs. Wash your hands of them’ was launched by
Several facilities joined the WHO observation survey and hygiene
Health Protection Scotland (HPS).
programme evaluations in hospitals or health services were also
presented. This year, the 5 May activities were extended to primary
Activities held throughout NHS Scotland to mark the call for action by
health care, while also including new groups such as primary schools
WHO on May 5 2010 were highly successful and aimed to promote
and the community: poster or drawing competitions for families,
awareness of the importance of hand hygiene among health-care
paediatric or mental health patients or local associations of the
workers, patients and the public. Local activities were supported by
mentally handicapped.
HPS with the provision of campaign materials including hand hygiene
For more information, newsletter and updates:
leaflets for health-care workers and members of the public in addition
http://www.seguridaddelpaciente.es/
to mouse mats, canvas bags and credit card-sized flyers depicting
the WHO ‘My 5 Moments for Hand Hygiene’.

State of Qatar
Fouzia Al-Naimi

Examples of local activities included displays of ultraviolet light boxes The Supreme Council of Health (SCH) held its second national

and the provision of awareness-raising campaign materials in campaign "Clean Care is Safer Care" for hand hygiene from 17 to 25

hospital foyers, a school hand hygiene poster competition, February 2010, sponsored by the Universal Trade Line Company in

information stand and poster display at a conference, training the State of Qatar. The aim was to ensure consistent and sustained

sessions, newsletters and the launch of posters suitable for paediatric improvement of hand hygiene among health-care providers in public,

settings. private and at all levels of the health sector. A press conference
inaugurated the campaign and emphasized the commitment of the
State of Qatar after signing the WHO statement pledging to address Comme dans bon nombre d'autres pays, une manifestation s'est
HAI. aussi tenue pour marquer la première journée nationale hygiène des
mains, célébrée le 05 mai 2010.
Well attended and highly rated lectures were conducted in private
and public hospitals by specialists in infection prevention and control.
Handouts, brochures and fliyrs related to hand washing techniques in
three languages (English, Arabic and Malayalam) were disseminated.
Non alcohol based hand rub provided by the company as well as roll-
ups were distributed. Hamad General Hospital (621 beds) and Al
Ahli Hospital (250 beds) distributed educational material to health-
care providers to emphasize the crucial role of hand hygiene in
preventing HAI.

Another educational session was organised on 5 May 2010 on the

importance of hand hygiene compliance. News media covered the
event. Hamad Medical Corporation (five hospitals), primary health-
care centres (22 centres) and Al Ahli Hospital (a private hospital) are
actively involved in training nurses and proceeding with the Global
Observation Survey on Hand Hygiene Moment 1.
Hand Hygiene Self-
Self-Assessment Framework
Sudan
This is a validated tool to help health-care facilities assess their hand
May Osman Gamar Elanbya
hygiene promotion and practices. There are 27 indicators organized
In Sudan, improving hand hygiene is an important strategic element
under the five core elements of the WHO Multimodal Hand Hygiene
of its infection prevention and control programme. In addition to
Improvement Strategy, to help assess each of them systematically.
distributing the WHO-recommended formula for alcohol-based
The framework can be used by health-care facilities around the
handrubs, a "Clean Hands for Safer Care" poster (see below) which
world, at any stage of progress in hand hygiene promotion to:
contains the "My 5 Moments for Hand Hygiene" as well as "how to
- assess the situation in individual health-care facilities with regards
hand wash and hand rub" was also distributed to all hospitals.
to infrastructure, resources, actions, commitment and achievements;
- facilitate the development of an action plan for improvement of the
situation;
- document progress over time through the repeated use of this tool.
http://www.who.int/gpsc/country_work/hhsa_framework/en/index.html

Using WHO tools for centrally coordinated

campaigns
The 'Using WHO hand hygiene improvement tools to support the
implementation of national/sub-national hand hygiene campaigns'
document aims to facilitate understanding of the 40 or so WHO tools
and guidelines related to hand hygiene promotion. It looks at
planning the use of these tools effectively in centrally coordinated

Tunisia national/sub-national campaigns involving several facilities. This, we

Hamza Ridha
Dans le cadre de la deuxième phase du programme national tunisien
d'hygiène des mains en milieu de soins, un cours national a été
organisé du 16 au 18 mars 2010 au profit des 48 relais régionaux
(deux relais par région) et sera suivi de cours régionaux (au courant
du deuxième trimestre 2010) et d'actions de formation à l'échelle des
établissements de soins (s'échelonnant sur trois semestres : 2010 -
2011) : formation en cascade.
hope, will be useful to you and others in your region who are setting
out to start a campaign. Please disseminate this information to those
interested in hand hygiene promotion involving multiple facilities.
http://www.who.int/gpsc/national_campaigns/PS_hand_hygiene_tools
_2010_6_en.pdf.
The next WHO CleanHandsNet newsletter will be published in December
2010. If you have any comments please send them to savelives@who.int